Health systems in transition : Uzbekistan

78
Fig. 5.1
Outpatient contacts per person in the WHO European Region, 2012 or latest 
available year 
Source
: WHO Regional Office for Europe, 2014a. 
Notes
: CIS: Commonwealth of Independent States; TFYR Macedonia: The former Yugoslav Republic of Macedonia.
2.3
3.5
3.5
3.8
4.5
4.5
6.5
6.9
9.1
9.5
10.7
12.9
2.2
5.4
5.4
6.0
11.1
6.3
11.8
6.3
7.2
4.4
6.8
4.5
7.6
11.0
6.5
6.1
2.3
3.1
3.8
4.0
4.0
4.2
4.2
4.6
5.0
5.2
6.1
6.2
6.6
6.6
6.8
6.9
7.0
7.4
7.4
8.2
9.7
6.9
7.2
8.9
Georgia (2012)
Turkmenistan (2012)
Kyrgyzstan (2011)
Armenia (2012)
Tajikistan (2012)
Azerbaijan (2012)
Republic of Moldova (2012)
Kazakhstan (2012)
Uzbekistan (2012)
Russian Federation (2012)
Ukraine (2011)
Belarus (2012)
CIS
Albania (2011)
Montenegro (2010)
Romania (2011)
Bosnia and Herzegovina (2012)
Bulgaria (1999)
Croatia (2011)
TFYR Macedonia (2011)
Estonia (2011)
Latvia (2011)
Slovenia (2011)
Poland (2011)
Lithuania (2011)
Serbia (2012)
Slovakia (2011)
Czech Republic (2011)
Hungary (2011)
Central and South-Eastern Europe
Cyprus (2011)
Sweden (2011)
Ireland (2010)
Greece (2006)
Switzerland (2007)
Finland (2011)
Portugal (2011)
Denmark (2010)
United Kingdom (2009)
Norway (2009)
Iceland (2011)
Israel (2009)
Luxembourg (2011)
Netherlands (2011)
France (2011)
Austria (2011)
Italy (2005)
Spain (2011)
Belgium (2011)
Turkey (2011)
Germany (2011)
Western Europe
EU members before May 2004 (2011)
EU members since May 2004 (2011)
CIS (2012)
0
3
6
9
12
15

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Health systems in transition
  
Uzbekistan
79
5.3.1 Public settings 
In rural areas, the first point of contact was historically the FAP, providing 
access to basic health care services to a catchment population of between 
600 and 3000. Staff provided basic curative, antenatal and postnatal care and 
undertook limited disease prevention and health promotion activities, such as 
immunization and health education. The posts were staffed by up to three health 
care workers, usually including a 
feldsher
 and a midwife. The next level of 
services in rural areas, rural outpatient clinics, were staffed with an average 
of four physicians. They usually included a specialist in internal medicine, a 
paediatrician, an obstetrician and a dentist. The third level of primary care 
consisted of the outpatient clinics of rural territorial or central 
tuman
 hospitals. 
This structure has been largely replaced by a two-tiered system, although 
a limited number of FAPs still exist. The first point of contact is the rural 
physician point, while secondary outpatient care is provided by outpatient 
clinics of central 
tuman
 hospitals. The number of primary care staff in this 
new “model” is determined by the size of the population covered. Four types of 
rural physician points have been determined, each with a specified number and 
type of personnel, space and equipment: level one will employ one physician 
to serve a catchment area of 1500–2500 inhabitants; level two will employ two 
physicians and serve 2500–3500 inhabitants; level three will provide three or 
more physicians to serve 3500–5500 inhabitants; and level four would represent 
a rural medical centre for training and education with 7–10 physicians. The 
number of training medical centres in rural areas is planned to be limited to 
one or two per 
viloyat
. They will serve as education centres in general practice 
for physicians and nurses.
In contrast to the previously existing teams of specialists, rural physician 
points are staffed by GPs, who lead the team efforts at the practice. Specialist 
physicians are being retrained to become GPs. It is envisaged that GPs will be 
the first point providers of primary health care in urban and rural areas in state 
health facilities. 
In urban areas, primary health care and selected secondary care services 
are provided by polyclinics, with catchment populations of between 10 000 and 
80 000 people. There used to be several types of polyclinics – for adults, 
children, and polyclinics specializing in women’s health. Recent trends in 
introducing general practice in rural areas are being replicated in urban areas. 
All types of polyclinics are currently being transformed into family polyclinics 
which provide primary care for all groups of the population. Polyclinic staff 
previously consisted of specialists in internal medicine, paediatricians and 

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Health systems in transition
  
Uzbekistan
80
other specialists. These specialists in urban family polyclinics are expected 
to be gradually replaced by GPs and, currently, specialists work alongside 
GPs. However, similar to the rural primary care model, 
tuman
 multi-specialty 
polyclinics will be staffed by specialists to whom GPs can refer difficult cases. 
Screening is a key function of primary care units. Primary care physicians 
should conduct regular screenings of different segments of the population, such 
as school children or pregnant women. Besides, screening is required by many 
employers in order to employ staff or by institutions of higher education as a